(a) A pharmacy has a right to request an informal hearing before the commission’s appeals division to contest the findings of an audit conducted by the commission’s office of inspector general or an entity that contracts with the federal government to audit Medicaid providers if the findings of the audit do not include findings that the pharmacy engaged in Medicaid fraud.
(b) In an informal hearing held under this section, staff of the commission’s appeals division, assisted by staff responsible for the commission’s vendor drug program who have expertise in the law governing pharmacies’ participation in Medicaid, make the final decision on whether the findings of an audit are accurate. Staff of the commission’s office of inspector general may not serve on the panel that makes the decision on the accuracy of an audit.

(c) In order to increase transparency, the commission’s office of inspector general shall, if the office has access to the information, provide to pharmacies that are subject to audit by the office, or by an entity that contracts with the federal government to audit Medicaid providers, information relating to the extrapolation methodology used as part of the audit and the methods used to determine whether the pharmacy has been overpaid under Medicaid in sufficient detail so that the audit results may be demonstrated to be statistically valid and are fully reproducible.

Text of section effective until April 01, 2025